CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(05): 491-498
DOI: 10.1055/a-1156-3991
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

SARS-CoV-2/COVID-19: Evidence-Based Recommendations on Diagnosis and Therapy

Article in several languages: English | deutsch
Berthold Bein
1  Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie der Asklepios Klinik St. Georg, Hamburg, Germany
,
Martin Bachmann
2  Klinik für Intensivmedizin und Beatmungsmedizin, Asklepios Klinikum Harburg, Harburg, Germany
,
Susanne Huggett
3  Krankenhaushygiene der Asklepios Kliniken, Hamburg, Germany
,
Petra Wegermann
4  Asklepios Klinik Weißenfels, Weißenfels, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 May 2020 (online)

  

Abstract

COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic posing serious challenges to healthcare systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 – 6 days; 5% of patients need intensive care therapy. Mortality is about 1 – 2%. Protecting healthcare workers is of paramount importance in order to prevent hospital-acquired infections. Therefore, during all procedures associated with aerosol production, personal protective equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and adequate management of organ failure are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies are evolving with ever increasing frequency; currently, however, no evidence-based recommendation is possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.

Core Statements
  • COVID-19 is a new viral disease that affects the respiratory system. The currently available data suggest that around 20% of cases develop severe symptoms, and around 5% of all cases require intensive care. Mortality is between 1 and 2% of all persons who develop the disease.

  • Adequate protection of medical staff is essential to prevent nosocomial infection. Medical staff must therefore wear personal protective equipment consisting of an FFP2/FFP3 mask, safety goggles and a waterproof overall during all aerosol-generating procedures.

  • Intensive care treatment of patients with lung failure is based on established recommendations for the treatment of patients with ARDS issued by the relevant professional societies. The focus is on lung-protective ventilation, prone positioning, restrictive fluid management and adequate management of other organ insufficiencies. Patients requiring extracorporeal membrane oxygenation must be treated in centres experienced in providing this type of organ support.

  • New and experimental treatment options are being discussed. However, based on the currently available evidence, it is not yet possible to recommend any of these approaches. In every case, an individual risk-benefit assessment is necessary prior to initiating the off-label use of particular substances as serious side effects have been reported.

Kernaussagen
  • COVID-19 ist eine neuartige virale Erkrankung, die die Atemwege befällt. Aktuell verfügbare Daten legen nahe, dass es in ca. 20% der Fälle es zu einem schwereren Krankheitsverlauf kommt, der in ca. 5% aller Fälle auch intensivmedizinische Maßnahmen erforderlich macht. Die Letalität beträgt zwischen 1 und 2% aller Erkrankten.

  • Eigenschutz des Personals ist essenziell, um eine nosokomiale Infektion zu vermeiden. Bei allen Aerosol produzierenden Maßnahmen ist daher eine Schutzausrüstung mit FFP2/FFP3-Maske, Schutzbrille und flüssigkeitsdichtem Kittel zu tragen.

  • Die Therapie intensivpflichtiger Patienten mit Lungenversagen basiert auf den etablierten Empfehlungen der Fachgesellschaften zur Behandlung von Patienten mit ARDS. Lungenprotektive Ventilation, Lagerungstherapie, restriktive Flüssigkeitsgabe und adäquate Beherrschung weiterer Organinsuffizienzen stehen hier im Mittelpunkt. Wenn eine Behandlung mittels extrakorporaler Membranoxygenierung nötig ist, sollte die Behandlung in erfahrenen Zentren durchgeführt werden.

  • Neue und experimentelle Therapieoptionen mit unterschiedlichsten Angriffspunkten werden zunehmend diskutiert; evidenzbasiert kann für keine dieser Therapien derzeit eine Empfehlung ausgesprochen werden. In jedem Fall ist vor Verwendung einer Substanz als Off-Label Use eine individuelle Nutzen-Risiko-Abwägung erforderlich, da auch die jeweiligen Nebenwirkungen beachtet werden müssen.